N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 511-1.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 511-1.1 - Background and Intent

(a) Federal law requires state Medicaid programs to offer Early and Periodic Screening, Diagnostic and Treatment to all Medicaid-eligible children under age 21. Commonly referred to as "EPSDT," these services are designed to support childhood growth and development to ensure that children in low income families receive the comprehensive and preventive health and behavioral health services they need. EPSDT services include appropriate preventive, dental, health, behavioral health, developmental and specialty services.

(b) Within the scope of EPSDT benefits under the federal Medicaid law, states are required to cover any service that is medically necessary "to correct or ameliorate a defect, physical or mental illness, or a condition identified by screening" and which are recommended by a Licensed Practitioner of the Healing Arts. Thus, EPSDT requires states not only to screen and diagnose health and mental health illnesses or conditions in low income children, but they must ensure children are provided treatment as well.

(c) New York State has obtained an amendment to its Medicaid State Plan that authorizes the provision of six new children's behavioral health and health services under the EPSDT benefit. When recommended by a Licensed Practitioner of the Healing Arts, these six services will be made available to any child eligible for Medicaid who meets relevant medical necessity criteria, and include:

(1) Crisis Intervention Services: services designed to interrupt and/or ameliorate a behavioral health crisis through the provision of support to an individual who may be experiencing a mental health crisis, and subsequently connecting such individual to appropriate resources. For purposes of this Part, provision of this services does not connote examination, diagnosis, care, treatment, rehabilitation, or training of a person with mental illness and thus does not constitute a nonresidential service requiring licensure under Mental Hygiene Law Section 31.02;

(2) Community Psychiatric Supports & Treatment: interventions intended to achieve identified goals or objectives as set forth in a treatment/ recovery plan;

(3) Family Peer Support Services: formal and informal services provided to families of a child experiencing social, emotional, developmental, medical, substance use, and/or behavioral challenges in their home, school, placement, and/or community;

(4) Youth Peer Support and Training: formal and informal services and supports to ensure engagement and active participation of youth in the treatment planning and implementation process;

(5) Other Licensed Practitioners: service provided by a non-physician behavioral health practitioner operating within a licensed children's mental health agency, who is licensed in New York and is operating within a scope of practice defined in New York State law in any setting permissible under such law, including community based settings; and

(6) Psychosocial Rehabilitation Services: task-oriented services designed to compensate for or eliminate functional deficits and interpersonal and/or behavioral health barriers associated with behavioral health needs.

(d) This Part is intended to establish standards applicable to providers of mental health services licensed or operated by the Office of Mental Health that wish to be designated, or have been designated, as a provider of EPSDT, Other Licensed Practitioners, and Community Psychiatric Supports and Treatment Services.

(e) This Part also establishes standards applicable to non-licensed providers of mental health services that receive funding or have a contract from the Office that wish to be designated, or have been designated, as a provider of any of the following EPSDT services: Crisis Intervention Services, Family Peer Support Services, or Youth Peer Support and Training and Psychosocial Rehabilitation Services.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 511-1.1

Renumbered from 511.1 New York State Register July 17, 2019/Volume XLI, Issue 29, eff. 7/17/2019